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Shrink rethink: rebranding psychiatry

  • Jim Crabb (a1), Lee Barber (a2) and Neil Masson (a3)
Summary

Negative public attitudes towards psychiatry hinder individuals coming for treatment and prevent us from attracting and retaining the very brightest and best doctors. As psychiatrists we are skilled in using science to change the thoughts and behaviours of individuals, however, we lack the skills to engage entire populations. Expertise in this field is the preserve of branding, advertising and marketing professionals. Techniques from these fields can be used to rebrand psychiatry at a variety of levels from national recruitment drives to individual clinical interactions between psychiatrists and their patients.

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Corresponding author
Jim Crabb, Forth Valley Royal Hospital, Stirling Rd, Larbert, FK5 4WR, UK. Email: jcrabb1@nhs.net
Footnotes
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Declaration of Interest

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Footnotes
References
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1 Maidment, R, Livingstone, G, Katona, M, Whitaker, E, Katona, C. Carry on shrinking: career intentions and attitudes to psychiatry of prospective medical students. Psychiatr Bull 2003; 27: 30–2.
2 Rajagopal, S, Redhill, KS, Godfrey, E. Psychiatry as a career choice compared with other specialties: a survey of medical students. Psychiatr Bull 2004; 28: 444–6.
3 Eagles, JM, Wilson, S, Murdoch, JM, Brown, T. What impact do undergraduate experiences have upon recruitment into psychiatry? Psychiatr Bull 2007; 31: 70–2.
4 Mahdawi, A. Marmite: love or hate its PR, you have to admit it's strong stuff. The Guardian 2011; 30 November (https://www.theguardian.com/commentisfree/2011/nov/30/marmite-love-it-hate-it-pr).
5 Gaebel, H, Zäske, H, Zielasek, J, Cleveland, HR, Samjeske, K, Stuart, H, et al. Stigmatization of psychiatrists and general practitioners: results of an international survey. Eur Arch Psychiatry Clin Neurosci 2015; 265: 189–97.
6 Davies, T. Recruitment into psychiatry: quantitative myths and qualitative challenges. Br J Psychiatry 2013; 202: 163–5.
7 Mittone, L, Savadori, L. The scarcity bias. Appl Psychol 2009; 58: 453–68.
8 Jones, R. 13 of the most creative recruitment campaigns. Recruit Buzz 2014; 18 August (http://recruitmentbuzz.co.uk/13-of-the-most-creative-recruitment-campaigns/).
9 Paris, M. Apple – think differently. This is Not Advertising 2011; 5 September (https://thisisnotadvertising.wordpress.com/2011/09/05/apple-think-different/).
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The British Journal of Psychiatry
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  • EISSN: 1472-1465
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Shrink rethink: rebranding psychiatry

  • Jim Crabb (a1), Lee Barber (a2) and Neil Masson (a3)
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eLetters

Psychiatry - A Golden Pathway towards Personal Growth

Larry Culliford, Author and retired psychiatrist, Royal College of Psychiatrists
01 June 2018

Dear Jim, Lee and Neil,

Congratulations on your article, which I have been thinking about since reading it some weeks ago. I fully agree with your aims (attracting doctors into psychiatry) and many of your arguments, but also have some reservations, which I would like to share.

In this age of internet 'click-bait', it seems, when advertisements are designed 'to create an anxiety relieved by a purchase', people are often naturally suspicious of advertising, branding and marketing. It is seldom fully truthful, misleading by presenting opinion as facts, by being selective of data, and by concealing flaws and inadequacies. This is the hype, spin or propaganda designed to sell products and maximise financial profit, and arguably therefore unsuitable for persuading medical students and young doctors to think about psychiatry as a long-term career path.

In the cold light of day, for example, particularly in today's evidence-based, politically governed, under-funded and over-stretched NHS, people might wonder how truthful are the statements comprising the mantra you propose for 'brand psychiatry'. The experience of a patient, or family members, might not be exactly as you describe. The rational, materialist, left-brain dominated 'scientific' approach - which tends to search out symptoms and diagnoses, and then to provide physical treatments (medication) and brief impersonal psychotherapies (like CBT), rather than seeking healing for the whole person, body, mind and soul - still prevails over a more holistic, intuitive, poetic, right-brain dependent, person-orientated approach, don't you think?

That said, I'm sure you are on the right track. It is a genuine ideal to be pursued: 'To understand the connection between the mind, the body and the soul', and, 'To have the rare ability to treat the person, not the problem'. But might not other doctors, particularly GPs, want to make similar claims?

An approach which might work well could be to stress the equal values of biological, psychological, social AND spiritual aspects of mental health care. In other words, giving the message that there is a welcome in psychiatry for people with a wide range of knowledge, skills and experience, enabling each to grow - through training and practice - in those areas and attributes previously less well developed. There is an important place for those whose abilities and preferences lie within the biological domain, still the 'comfort-zone' for many psychiatrists; but the aim, I suggest, is both to encourage such folk to broaden their horizons, and to encourage new people to embrace the specialty whose inclinations are more towards (to paraphrase the mantra) 'feeling with one's mind' and 'thinking with one's soul'. Arguably, this means fostering awareness and familiarity with the spiritual dimension of mental health care. Some may be surprised to know that this valuable - and hitherto neglected - aspect of our discipline can be taught. (Ref: Culliford, L (2009) Teaching Spirituality and Health Care to 3rd Year Medical Students, in The Clinical Teacher; 6: 22-27.)

An axiom for this re-branded psychiatry would be that everyone is on some kind of self-improvement pathway towards a maturity that involves personal integration, with continuing growth in terms of wisdom, compassion and love, derived from a sense of belonging not to any faction but to the entirety of humanity, similarly connected seamlessly to nature, and to the dynamic structure and energy of the cosmos which underpin all the natural laws known to science. To become a psychiatrist would thus offer an unparalleled opportunity for making progress along this (I would call it 'spiritual') path.

As you have hinted, personal sacrifices are necessary. It is a tough, and occasionally dangerous profession. It is not too hard academically, but it is challenging at a deeply personal level. Compassion - 'suffering with' one's patients and their carers, also one's colleagues - means feeling and sharing the emotional pain and distress of others. As I have written about extensively elsewhere (Ref: Culliford, L. (2018) 'Seeking Wisdom - A Spiritual Manifesto'. Buckingham: Buckingham University Press), it is this very suffering, acting as a kind of medicine, which affords the best opportunity to initiate healing from life's inevitable psychological traumas, threats and losses, resulting in the deepest satisfaction that human experience can offer, which is inherent in personal growth. To become wiser, kinder, humbler, more truthful and tolerant, enjoying lower levels of anxiety, anger, sorrow, doubt, confusion, and greater levels of equanimity and self-esteem, accompanied most often by the heartfelt esteem of others, are among the inestimable rewards to be garnered. This is undoubtedly what I have gained most from becoming and working as a psychiatrist.

Yours sincerely,

Larry Culliford.
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Conflict of interest: None declared

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Rethinking rebranding

Stephen Ginn, Consultant Psychiatrist, Camden and Islington Foundation NHS Trust
24 January 2018

Recruiting sufficient psychiatrists in the UK apparently resists straightforward remedy. Crabb et al’s recent editorial Shrink rethink: rebranding psychiatry (1) is a welcome contribution on this subject. Innovative and provocative in turn, it urges that the psychiatric profession draw on expertise from the fields of advertising and public relations. We should engage with potential recruits by thinking of psychiatry as a 'brand'.

But brands are ethereal things. Their existence is championed by some (2), whilst others have written about the negative impacts of brand-orientated corporate activity (3). Marketing psychiatry as a brand certainly has an attractive simplicity. Yet doing so situates the practice of psychiatry in the realm of things that are bought and sold, where it sits only uncomfortably.

The ubiquity of some brands is a marketing triumph, but emulating their tactics is not necessarily desirable. The advertising of brands seeks to sow discontent; to demonstrate to customers a gap in their life experience that a product can fill. Attempts to promote brands and products by association with certain desirable lifestyles may be effective, but also disingenuous. This approach may be acceptable for a soft drink, but should be approached with caution by the medical profession.

In addition the management priorities of the corporations that own many brands only faintly resemble psychiatry’s governance structures. Psychiatry’s relationship with its ‘competitors’ is more complex. If one company enters administration as a result of the crushing success of a rival, then that’s capitalism ‘working’. But if by increasing psychiatry’s share of trainee recruitment we substantially weaken a fellow specialty, this success is equivocal.

Arguably, acknowledged or not, psychiatry is a brand of sorts. Doctors making career decisions may be accustomed to thinking of themselves as consumers and consider their options in a transactional way. In this case the explicit branding of psychiatry makes some sense, and in recognizing this possibility Crabb et al provide a valuable insight. But promoting psychiatry as a brand may mean that other ways of understanding how our specialty might appeal are overlooked. What I hope is not lost is the notion of the new recruits to psychiatry’s ranks as engaged citizens, drawn to this specialty as an expression of deeply held values and as a demonstration of commitment to their community and to wider society.

References

1. Crabb, J., Barber, L., Masson, N Shrink Rethink: rebranding psychiatry Br. J. Psychiatry (2017) 211, 259-261

2. The Case for Brands The Economist 2001: 8-14 September

3. Klein, N. No Logo (10th anniversary ed.). Fourth Estate: 2010

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Conflict of interest: None declared

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Shouldn’t we instead be preaching to the already converted?

Ranjita Howard, Psychiatry Registrar CT3, Tees, Esk and Wear Valleys NHS Foundation Trust
27 December 2017

I welcome the ideas in this article and agree that a lot more needs to be done to reform the negative image of psychiatry that is still widely held amongst the general public and within the medical profession itself. I find it particularly alarming that a lot of the damage, with respect to recruitment numbers at least, seems to be done during the medical school years given the considerable reduction of those who view psychiatry favourably i.e. from 49% on entry (Maidment et al, 2003) to 3% on graduation (Rajagapal et al, 2004). Indeed, I myself faced judgement from my medical student peers for voicing my consideration of psychiatry as a career, to the point where I did deliberate over whether it was the right specialty for me. I still have echoes of ‘Yeah, but it’s so woolly, a lot of mumbo-jumbo’, ’But the patients never get better’, and the old chestnut, ‘It’s not even based on any real science’. Thankfully, and with absolutely no regrets, I find myself mid-stream of my psychiatry training and regard myself as lucky for working in a profession that I truly love. The challenges of dealing with the uncertainties and the complexities of finding solutions to problems that transcend the simple biological paradigm are something that I can identify with and love facing on a daily basis.

So, I ask myself, why did I, unlike so many others, follow through with my long standing intentions to pursue a career in psychiatry? Maybe the antagonism and bad mouthing I experienced during medical school wasn’t as bad for me as it was for those who defected to other specialties. Maybe my interest was sustained through being lucky enough to be inspired by a charismatic senior colleague or the occasional interesting case. Or maybe I was just more resilient in my belief to be become a psychiatrist. To be honest, I’m not really sure whether I can put my finger on any single significant factor. All I am sure about is that I’ve always wanted to become a psychiatrist and, despite the odd wobble, have never really wavered irrespective of what I faced at medical school, or heard in the the media for that matter.

Given this, and in light of the article’s focus on targeting ‘brand psychiatry’ at medical students, I also ask myself, are we just maybe missing a trick here? I mean, I appreciate the importance of assertively utilising certain marketing and branding messages to engage your audience, but another no-less critical component of marketing best practice is to segment populations to more efficiently target ‘products’ or ‘services’ to the most relevant audience possible. Much like, I suppose, when supermarkets send you vouchers for similar items to those you’ve already bought, or websites that chase you with popups to remind you of an item you’ve looked at previously. What if, therefore, instead of trying to generically fight against the grain of existing cultural dogma within medical schools (of which we know there is plenty), we try and preach ‘brand psychiatry’ to the already converted (i.e a more relevant audience) before they even step foot on a medical school campus. Indeed, despite the seeming damage that medical school can do to psychiatry recruitment numbers, it has been reported that a premedical interest in psychiatry (something that I certainly held) remains the strongest predictor for choosing this specialty as a career (Gowans et al, 2011). Moreover, research shows that of the 2.7% who had a desire to become a psychiatrist on entering medical school, 78% still remained committed by year 5, indicating considerable decision stability amongst our kin (Farooq et al, 2014), and an independent mindset that is less influenced by existing dogma and prestige (Malhi et al, 2003).

Okay, so where are we to find this ‘more relevant’ premedical audience who are already strong believers in the bio-psychosocial model, who already embrace a scientific and arts based discipline as well as our ‘rich and controversial heritage’, and who are certainly not scared of taking on those questions that tend to be more ambiguous, complex and challenging? Well, given that research shows that psychology graduates are three times more likely to pursue a career in psychiatry than those with non-psychological backgrounds (Brown, 2012; Shields et al, 2017), I would suggest that the more scientifically robust psychology departments across the UK would serve as fertile ‘windows of opportunity’ from which to target a national recruitment campaign and make up some of the deficit needed to fill all the psychiatry training posts in the UK. Moreover, much like the typically determined student psychiatrist, the typical profile of a psychology graduate suggests that not only would they be more independently minded and therefore less likely to be swayed by the existing cultural dogma and ‘corrosive bad mouthing’, but they would be much more likely to unashamedly champion the values and intentions of psychiatric theory and practice and consequently help in cascading a more positive image to their peers. Okay, sure, I suppose we would make up some numbers by directly targeting medical students and ‘selling’ our field through being unashamedly elitist, through ‘selling’ what the profession has already achieved, and through ‘selling’ the notion that we are all pioneers in our search to alleviate mental suffering. But, we need to ask ourselves, do we want to be ‘selling’ ourselves and ‘just about’ convincing those on the fence to enter into our profession? Or do we want to attract people who always have and always will see people holistically? People who are already passionate in their intentions to radically transform the whole lives of patients. People who do instinctively ‘feel with their mind and think with their soul’. Surely, these are exactly the kind of people who can bring psychiatry ‘to life every day and every time they come into contact with colleagues and students’, and potentially the kind of people who could not only help in our pioneering quest of rescuing souls but also help in rescuing our very profession from being ‘lost in the unchartered reaches of outer space’.

References

Brown, T (2012) Recruitment Strategy 2011-2016. Royal College Psychiatrists.

Farooq, K., Lydall, G.J., Malik, A., Ndetei, D.M., Bhugra, D (2014) Why medical students choose psychiatry - a 20 country cross-sectional survey. BMC Med Educ, 14: 12.

Gowans M.C, Wright B.J, Brenneis F.R, Scott I.M (2011) Which students will choose a career in psychiatry? Can J Psychiatry, 56: 10, 605–13.

Maidment R, Livingstone G, Katona M, Whitaker E, Katona C (2003) Carry on shrinking: career intentions and attitudes to psychiatry of prospective medical students. Psychiatr Bull, 27: 30–2.

Malhi GS, Coulston CM, Parker GB, Cashman E, Walter G, Lampe LA, et al, (2003) Who picks psychiatry? Perceptions, preferences and personality of medical students. Aust N Z J Psychiatry, 45: 861–70.

Rajagopal S, Redhill KS, Godfrey E. (2004) Psychiatry as a career choice compared with other specialties: a survey of medical students. Psychiatr Bull 2004; 28: 444–6.

Shields, G., Ng, Roger., Ventriglio, A, et al, (2017) WPA Position Statement on Recruitment in Psychiatry. World Psychiatry 16: 1, February.

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Conflict of interest: None Declared

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Rebranding psychiatry: not only a matter of attracting talent but also keeping psychiatrists inspired.

Joeri K. Tijdink, psychiatrist and researcher, VU Universiteit, department of Philosophy, Amsterdam, the Netherlands
Jurjen J. Luykx, Psychiatrist and researcher, Brain Center Rudolf Magnus, department of psychiatry, UMC Utrecht, Utrecht, the Netherlands
Thomas Pattyn, Psychiatrist in training, University of Antwerp, Department of Medicine, Belgium
Anouck Visser, Psychiatrist, Altrecht, Utrecht, The Netherlands
Christiaan H. Vinkers, Psychiatrist and assistant professor, Brain Center Rudolf Magnus, department of psychiatry, UMC Utrecht, Utrecht, the Netherlands
20 November 2017

Dear editor,

With great interest we read the article of Crabb and colleagues entitled Shrink rethink: rebranding psychiatry recently published in your journal, convincingly making a case why it is important to rethink our ‘brand’ psychiatry and the importance of self-confidence for psychiatrists.

Negative public attitudes towards psychiatry are omnipresent, also in the Netherlands and Belgium. In the eyes of medical students, psychiatry is sometimes perceived as a soft, inconsistent, ineffective or even pseudoscientific plenty-of-empathy specialty. To convince people otherwise, we need to go beyond preaching to the choir. This is why we very much welcome Crabb and colleagues’ (1) take on a novel, progressive way to express our professional pride.

This professional pride was the subject of a survey entitled “Proud2bPsy“, recently conducted by a number of young Dutch and Belgian psychiatrists. In total, almost 900 psychiatrists and psychiatry residents responded and answered questions on their professional attitudes and pride on being a psychiatrist. Despite the stress that psychiatrists experience related to the major challenges that the field has to overcome (including bureaucracy and budget cuts), there was an overall high level of pride to be a psychiatrist. On a scale from 1-10, Dutch psychiatrists rated their professional pride at 7.4 (95% CI 7.2-7,6) with retrospectively assessed levels of pride remained stable over a five-year period. Being proud was mostly attributed to the role that psychiatrists can play in the management of patients and their meaningful engagement with patient care (84%) and the efficacy of psychotherapy (60%) and pharmacotherapy (54%). They felt most pullback in their pride by the bureaucracy overload (75%).

The proposed rebranding of psychiatry can certainly help to overcome the existing negative stereotypes and prejudices and convert them towards more positive ones. As a group of young psychiatrists, we wonder how it is possible that a young, promising, and vibrant specialty that focuses on the most complex aspect of the human body is relatively unpopular among medical students? Dutch residency programs, especially those in more rural areas have problems finding suitable residents. This has a direct negative impact on the quality of psychiatric care and may discourage future bright young individuals wanting to sink their teeth in the challenges that psychiatry faces.

We firmly believe that inspiring, enthusiastic, enigmatic, charismatic leaders will conquer the minds of young medical students for psychiatry. Furthermore, we should not only rebrand psychiatry for our future colleagues, but we must aim to vitalize and stimulate the current population of psychiatrists. Proud to be psychiatrist and self-confidence are evidently present but hidden under a blanket of bureaucracy and numerous budget cuts. As psychiatrists, we surely have high levels of enthusiasm, inspiration, dedication and determination, but any improvements will funnel into young colleagues’ early career choices. For the time being, we try to conquer young psychiatry-prone medical students to seduce them into a career in psychiatry while maintaining our self-confidence and professional pride high; within ourselves and our colleagues.

Our Dutch platform The Young Psychiatrist (De Jonge Psychiater, www.dejongepsychiater.nl) is happy to facilitate this complex and challenging mission and we are determined to continuously show our ongoing passion for psychiatry that may keep others inspired.

(1)Crabb J, Barber L, Masson N. Shrink rethink: rebranding psychiatry. Br J Psychiatry (2017) 211, 259-261

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Conflict of interest: All authors are member of the Dutch platform The Young Psychiatrist (De Jonge Psychiater, www.dejongepsychiater.nl) that is an independent platform with the aim to translate research into clinical practice and foster positive attitudes towards psychiatry in biomedicine and in society.

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